Transcatheter Aortic Valve Replacement: Full Unilateral Access Using the Ipsilateral Superficial Femoral Artery Is...

Access site complications are very common complications in transcatheter aortic valve replacement (TAVR). Usually, a second arterial sheath is placed either in the contralateral femoral artery or in the radial artery as a simplified approach. This study aimed to investigate the safety and effectiveness of a full unilateral access using the ipsilateral superficial femoral artery (iSFA) in TAVR and to determine whether it simplifies the procedure.

This single-center retrospective audit analyzed the first 100 TAVR cases between February 2022 and January 2023 using iSFA as default secondary access. The primary outcomes included 30-day device success, bleeding, and vascular access-related complications. The last 100 bilateral cases and all bilateral cases (n = 656) served as controls.

Of the 143 transfemoral TAVRs performed during the study period, 43 patients were excluded. The remaining 100 patients (median age, 84 years; interquartile range, 80-89 years; median EuroSCORE II, 2.46; interquartile range, 1.65-3.97) were analyzed. The vascular access-related complication rates were 11% (main access, 55%; secondary access, 45%), with a 97% device success rate. In the control group of all bilateral cases, device success and vascular access-related complication rates were 93% and 17%, respectively. In the experimental group, access complications were promptly managed in the catheterization laboratory. All cases requiring interventions other than manual compression were successfully managed using iSFA.

The total unilateral approach using iSFA was safe and effective, shortening the time to address main access complications, providing ergonomic advantages for operators, and enhancing patient comfort.